What are the symptoms of PTSD?
The Diagnostic and Statistical Manual (DSM-IV) outlines the following possible symptoms of post traumatic stress disorder and classifies them into three categories: re-experiencing, avoidance, and arousal. These are symptoms that last for longer than one month, cause significant psychological distress and hinder one’s ability to function.
There is no set time frame for those who have PTSD to begin showing symptoms after a traumatic event occurs, because it’s possible to suffer trauma and not experience symptoms until months or years later when something – a sight, sound, word, or similar experience – brings back a traumatic memory. Stress can also accumulate over time until one “final straw” brings all the symptoms to the surface1.
Recognizing the symptoms of PTSD is integral in getting professional help, and The Ghost Rider Foundation aims to be a useful resource in helping veterans understand PTSD and get appropriate treatment as soon as possible. The symptoms associated with PTSD lead one to feel alone and helpless. Hopefully, by identifying with the following symptoms, veterans will see that they are not alone in their feelings, they aren’t crazy, and there is treatment available to recover from their trauma.
1. Re-experiencing
Someone with PTSD will persistently re-experience the traumatic event, and the act of re-experiencing can manifest itself in a variety of ways. One might have continual and disturbing recollections of the traumatic event, which could include thoughts or images relating to the event that occurred. Having recurrent dreams about the traumatic event is also a form of re-experiencing. Another form is feeling as though the traumatic event is happening again, which could take the form of flashbacks, illusions, or hallucinations2. The National Center for Posttraumatic Stress Disorder explains that these episodes of re-experiencing can be triggered by a sights, sounds, smells or even words that can be reminders of the traumatic event. For instance, hearing a motor vehicle backfire can remind a veteran of the sound of gunfire. Seeing a news report on an event similar to the traumatic event experienced could also cause one to relive the traumatic event3.
If being exposed to these sights and sounds or internal thoughts or dreams causes intense psychological distress, then that is a sign that person is re-experiencing the event and could have PTSD. Another symptom is to physically react to these cues2. For example, one veteran can’t attend July 4 celebrations because he says the sound of the fireworks is an auditory trigger – a sound that is similar to that of combat – that would make him begin to cry, shake, and sweat4.
2. Avoidance
Avoidance and numbing are also key signs of post traumatic stress disorder. A person will experience avoidance by making an effort to prevent thoughts and feelings associated with the trauma from taking shape. This leads to avoiding conversations associated with the trauma, including not wanting to talk about the trauma at all in order to keep those feelings suppressed. Avoiding activities, places, and people that would bring about recollections of the event also is a symptom. For example, a veteran might avoid other veterans because it reminds him or her of the traumatic event. One also might not be able to recollect an important aspect of the trauma. This is the brain’s way of avoiding the intense psychological distress associated with the event.
Numbing is also an integral symptom when diagnosing post traumatic stress disorder. Signs of numbing involve behavior that was not present before the traumatic event occurred, which includes a significantly decreased interest in activities that would be routine or normal to participate in. One might feel detached or estranged from other people, and also might have a smaller range of emotions, leaving him or her unable to, for instance, feel love.
An inability to see a future also is a symptom of numbing. One predicts a short future for him or herself, and does not expect to have a normal life span, get married, have children, or have a career2.
3. Arousal
Continual symptoms of increased arousal which were not present before the traumatic event occurred also are a sign of post traumatic stress disorder. An inability to fall asleep or stay asleep, irritability or outbursts of anger, and difficulty concentrating are some of the possible symptoms of PTSD2. One might have nightmares related to the traumatic event, making sleep undesirable for someone trying to avoid flashbacks of the experience. A heightened state of arousal can come about from any feelings of fear or anxiety, so recollections of a traumatic event and all the feelings associated with it can surface simply from a situation where someone with PTSD feels anxious or afraid and not necessarily from an obvious trigger such as a sight or sound1. There also could have been biological responses to the trauma that, when occur again, serve as a trigger for the traumatic event. For instance, when the traumatic event occurred, the person most likely had an elevated heart rate if they felt intense fear. Activities associated with an elevated heart rate, such as exercising, could serve as a trigger for recollections of the trauma1.
Hypervigilance is another symptom of PTSD, which means one has a heightened sense of awareness of his or her environment5. This is where the next symptom, an exaggerated startle response2, stems from, because one is much more aware of the sights, sounds, and people around him or her. One constantly feels as though he or she is in a state of danger. For some, the backfire of a motor vehicle blends into background noise. But if that is a trigger for a traumatic event for a veteran because of its resemblance to gunfire, he or she will have a much more profound response and feel threatened.
The National Center for Posttraumatic Stress Disorder refers to this symptom as hyperarousal, whereby one is always on alert and anticipates danger. Because the initial event often involves feelings of fear and helplessness, one constantly fears for his or her own safety and always feels on guard3.
Survivor’s Guilt
Survivor’s guilt is when one takes the responsibility for the outcome of an event that involves the serious injury or death of others. One might hold him or herself accountable for the outcome and feel as though if he or she would have acted differently, those lives lost could have been spared. One might feel guilty for surviving an event that others did not, and he or she might feel as though being alive is a sign of cowardice. Those with survivor’s guilt feel helpless and powerless because they could not control the situation. They blame themselves for any casualties or serious injuries, often believing their survival means that they didn’t do enough to prevent others from harm’s way6. Survivor’s guilt is another symptom of PTSD. Substance Abuse
Research has shown that substance abuse and PTSD have high rates of occurrence together7, and if someone is abusing drugs or alcohol after returning from military service and did not have a problem before, that can also be a symptom of PTSD. Some studies have shown that certain people have a genetic disposition to substance abuse8, so the stress of the trauma could bring about those tendencies while trying to cope.Alcohol abuse is often used as a way to calm nerves that are on high alert because of the hypervigilance mentioned above, and drug abuse is more commonly associated with trying to suppress or avoid re-experiencing the traumatic event9. For someone who does not feel comfortable seeking professional help, self-medication with alcohol or drugs is a way to escape the depression, guilt, fear, and helplessness that is associated with PTSD. This creates a dependency because one becomes reliant on the substance to relieve symptoms. Even picking up smoking can be a signal of PTSD, because that person is exhibiting addictive behavior that wasn’t present before the trauma occurred.
Other signs of PTSD
The NCPTSD also mentions other problems that are not direct psychological or physical symptoms, but they could be consequences of those symptoms in one’s personal life. These include employment and relationship problems3. Other physical symptoms like headaches, stomach aches, and chest pains are also responses to PTSD10. Some research has shown that when shown triggers, such as images of Vietnam, there were different physiological and neurological responses between Vietnam veterans who have seen combat and developed PTSD and those who have not. Those with PTSD had higher blood pressure and heart rates, and those with PTSD also had different levels of activity in certain parts of the brain11.
FOOTNOTES
1. Allen, Ph.D., Jon G. Coping with Trauma: A Guide to Self-Understanding. Washington, D.C.: American Psychiatric P, 1995.
2. Diagnostic and Statistical Manual. 4th ed. Washington D.C.: American Psychiatric Association, 2000.
3. "What is Posttraumatic Stress Disorder?" National Center for Posttraumatic Stress Disorder. 30 Nov. 2007. United States Department of Veterans Affairs. 7 July 2008 <http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_what_is_ptsd.html>.
4. Marcius, Chelsia. "Wounded Warriors Project Reaches Out to Veterans." Hudson Hub-Times 29 June 2008. 7 July 2008 <http://www.hudsonhubtimes.com/news/article/4006052>.
5. "Hypervigilance." Merriam-Webster's Medical Dictionary. 2008. Merriam-Webster. 7 July 2008 <http://medical.merriam-webster.com/medical/hypervigilant>.
6. Marzo, Psy.D., Donna. "Why Not Me? Dealing with Survivor Guilty in the Aftermath of a Disaster." Selfhelp Magazine 2008. 7 July 2008 <http://www.selfhelpmagazine.com/articles/trauma/guilt.html>.
7. "Worse Outcomes for a Substance-Abuse Disorder Likely When Accompanied by PTSD." Medical News Today 5 Mar. 2008. 9 July 2008 <http://www.medicalnewstoday.com/articles/99536.php>.
8. Scherrer, Jeffrey F., Hong Xian, Michael J. Lyons, Jack Goldberg, Seth A. Eisen, Willian R. True, Ming Tsuang, Kathleen K. Buckolz, and Karestan C. Koenen. "Posttraumatic Stress Disorder; Combat Exposure; and Nicotine Dependence, Alcohol Dependence, and Major Depression in Male Twins." Comprehensive Psychiatry 49 (2008): 297-304. 9 July 2008 <http://linkinghub.elsevier.com/retrieve/pii/S0010440X07001678>.
9. "Combat-Related Posttraumatic Stress Disorder and Severity of Substance Abuse in Vietnam Veterans." NCBI. 1992. Department of Health and Human Services. 9 July 2008 <http://www.ncbi.nlm.nih.gov/pubmed/1619930>.
10. "Post-Traumatic Stress Disorder: Symptoms, Types and Treatment." Helpguide. 2008. 7 July 2008 <http://www.helpguide.org/mental/post_traumatic_stress_disorder_symptoms_treatment.htm>.
11. Brewin, Chris R. Posttraumatic Stress Disorder: Malady or Myth? New Haven: Yale UP, 2003.